- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $3,019.95 / $9,332.54
| Facility | | $275.42 | $3,019.95 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $141.25 / $588.84
| Professional | | $112.20 | $141.25 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $4,570.88 / $12,882.50
| Facility | | $2,511.89 | $4,570.88 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $208.93 / $363.08
| Professional | | $120.23 | $208.93 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $416.87 / $46,773.51
| Facility | | $208.93 | $416.87 | $46,773.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $186.21 / $407.38
| Professional | | $120.23 | $186.21 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,623.41 / $12,302.69
| Facility | | $1,819.70 | $5,623.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $147.91 / $275.42
| Professional | | $104.71 | $147.91 | $275.42 |